Questions come up every month from medical office staff at internal medicine clinics: "Can we bill the specific disease management fee on the day of the first visit?", "Can the main disease be anything?", "I heard gastric ulcers were removed in FY2026 — what actually changed?" This article summarizes the points, requirements, eligible diseases and combination rules of the specific disease management fee, based on the FY2026 medical fee schedule (public notice), the implementation notice (Hoi-hatsu 0305 No. 6), and the public notice on facility standards that defines the eligible diseases (FY2026 MHLW Public Notice No. 71).
Disclaimer: This article is general information based on publicly available information as of October 19, 2026. The MHLW public notices and notifications are the authoritative source for points, requirements and eligible diseases. Always confirm the latest original text and the handling of your regional bureau of health and welfare and review body before making billing decisions.
Overview of the specific disease management fee
The specific disease management fee (category B000) evaluates planned management by a community family doctor with primary care functions — management of medication, exercise, nutrition and so on, based on a treatment plan — for patients whose main disease is one of the diseases designated by the Minister of Health, Labour and Welfare (implementation notice).
Points
| Category | Points | Frequency |
|---|---|---|
| Clinic | 225 | Up to twice a month |
| Hospital with fewer than 100 licensed beds | 147 | Up to twice a month |
| Hospital with 100–199 licensed beds | 87 | Up to twice a month |
| Using information and communication devices (notification required): clinic / under 100 beds / 100–199 beds | 196 / 128 / 76 | Up to twice a month (in place of the standard points) |
Hospitals with 200 or more licensed beds cannot bill it (implementation notice). Management using information and communication devices can be billed by a medical institution that has notified the regional bureau under the designated facility standards, when it follows the online care guidelines.
Basic billing rules
| Item | Handling (public notice and implementation notice) |
|---|---|
| Eligible patients | Patients whose main disease is one of the designated diseases (list below). Inpatients can never be billed |
| Content of management | Management of medication, exercise, nutrition and so on based on a treatment plan. Record the key points of the management in the chart |
| Frequency | Up to twice a month |
| Main disease | The specific disease at the center of the patient's overall medical management. Not billable by an institution that only performs tests on consultation or request |
| Multiple departments | In the same institution, billed only by the department treating the main disease |
| Management through family | Billable when there is a planned treatment plan based on examination and it is unavoidable for management to be given through the family member caring for the patient |
| Actual practice | Not billable if management centered on the main disease is not actually performed, or if the main disease is not actually treated at that institution |
The one-month rule after the first visit
The point most often misapplied is the relationship with the first visit date (or discharge date).
- Public notice: management performed on the day of a first visit for which the initial consultation fee is billed, or within one month of that day, is included in the initial consultation fee
- Implementation notice: the first specific disease management fee is billed on or after the day one month has passed from the first visit date (or from the day of discharge from that institution)
- Exception 1: if the day one month later is a holiday, and the requirements are met on a day that is not the holiday immediately before it, it can be billed on that day
- Exception 2: if the day one month later falls on the first of the month after next, and the requirements are met on the last day of the month following the first visit (or discharge) month (the day before if it is a holiday), it can be billed on that day
In short, billing the fee in the month of the first visit is generally wrong. Check that your billing software can check the elapsed days from the first visit.
List of eligible diseases (FY2026 public notice)
The eligible diseases are set in Appendix Table 1 of the public notice on facility standards for specified medical treatment fees. The Appendix Table 1 after the revision by FY2026 MHLW Public Notice No. 71 is as follows.
| Category | Eligible diseases |
|---|---|
| Infection and tumors | Tuberculosis; malignant neoplasms |
| Endocrine and metabolic | Thyroid disorders; postprocedural hypothyroidism; sphingolipid metabolism disorders and other lipid storage disorders; mucolipidosis; lipoprotein metabolism disorders and other lipidemia (limited to hereditary diseases such as familial hypercholesterolemia); lipodystrophy; Launois-Bensaude adenolipomatosis |
| Cardiovascular | Ischemic heart disease; arrhythmia; heart failure |
| Cerebrovascular | Cerebrovascular disease; transient cerebral ischemic attacks and related syndromes |
| Respiratory | Simple chronic bronchitis and mucopurulent chronic bronchitis; unspecified chronic bronchitis; other chronic obstructive pulmonary disease; emphysema; asthma; status asthmaticus; bronchiectasis |
| Digestive | Gastric ulcer and duodenal ulcer (excluding cases receiving a nonsteroidal anti-inflammatory drug that is contraindicated for patients with peptic ulcer); gastritis and duodenitis; liver disease (limited to chronic courses); chronic viral hepatitis; alcoholic chronic pancreatitis; other chronic pancreatitis |
| Other | Precocious puberty; sex chromosome abnormalities |
Points to note:
- Diabetes, hypertension and general dyslipidemia are not on this list. They are covered by the lifestyle disease management fee. Dyslipidemia is covered only as "lipoprotein metabolism disorders and other lipidemia" limited to hereditary diseases such as familial hypercholesterolemia. See Lifestyle Disease Management Fee I vs II for details
- Disease names follow the classification in the Statistical Classification of Diseases, Injuries and Causes of Death (MIC Public Notice No. 35 of 2015). A different local name is acceptable if the medical content is the same, but using the names in the classification table is recommended to avoid confusion
- "Liver disease" is limited to chronic courses. Acute liver disease is excluded
FY2026 change: gastric ulcer and duodenal ulcer
In the FY2026 revision, the eligible diseases for the specific disease management fee and for the specific disease prescription management addition on the prescription fee and prescription slip fee were revised as follows (MHLW revision outline, public notice).
| Before | After | |
|---|---|---|
| Peptic ulcer | Gastric ulcer, duodenal ulcer | Gastric ulcer and duodenal ulcer (excluding cases receiving a nonsteroidal anti-inflammatory drug that is contraindicated for patients with peptic ulcer) |
The MHLW outline explains that patients receiving a nonsteroidal anti-inflammatory drug that is contraindicated for patients with peptic ulcer are excluded from gastric and duodenal ulcer. In other words, gastric and duodenal ulcers were not excluded across the board. Only cases receiving such a contraindicated NSAID are removed from the eligible group.
In practice, it helps to decide the following:
- For patients whose main disease is gastric or duodenal ulcer, check whether a relevant NSAID is among the prescribed drugs
- If it is hard to judge whether a drug applies, the physician should confirm and record the grounds in the chart
- If it applies, the case falls outside both the specific disease management fee and the specific disease prescription management addition, so review the check conditions in your billing software
Which drugs count as "a nonsteroidal anti-inflammatory drug that is contraindicated for patients with peptic ulcer" is judged from the package insert. This article does not indicate whether any specific drug applies.
Management fees that cannot be combined
Many other management fees cannot be billed together with the specific disease management fee. Main examples:
| Situation | Handling |
|---|---|
| Other specific-disease management fees in the same month | Under the general rules for medical management, viral disease guidance, pediatric specific disease counseling, pediatric outpatient guidance, epilepsy guidance, intractable disease outpatient guidance, dermatology specific disease guidance, chronic pain disease management, pediatric malignant tumor patient guidance, ENT specific disease guidance, home care guidance fees and psychosomatic therapy cannot be billed in the same month unless otherwise specified |
| Pediatric specific disease counseling, epilepsy guidance, intractable disease outpatient guidance, pacemaker guidance, post-transplant patient guidance | Each note says it is not billed for a patient for whom the specific disease management fee is billed |
| Continuing management to prevent heart failure readmission | The specific disease management fee (limited to patients whose main disease is heart failure) cannot be billed separately |
| Dementia specialist diagnosis management fee | The specific disease management fee cannot be billed separately |
| Outpatient and home psychotherapy | Not billed for a patient for whom the specific disease management fee is billed |
| Month in which the comprehensive home care fee or facility-resident comprehensive fee is billed | The specific disease management fee cannot be billed |
| Patients receiving guidance for which the dermatology specific disease guidance fee or a home care guidance fee is to be billed | The management cost is included in each guidance fee |
| Inpatients and within one month of discharge | Management for inpatients and within one month of the discharge date is included in the basic inpatient fee |
"Cannot be billed in a month when another fee was billed" is a rule often flagged in electronic claim cross-checks and review. We recommend a month-end list check for patients with multiple management fees.
Check together: the specific disease prescription management addition
The specific disease prescription management addition uses the same Appendix Table 1 (an addition to the prescription fee and prescription slip fee).
| Item | Content |
|---|---|
| Points | 56 points (per prescription, once a month) |
| Eligible | Clinics or hospitals with fewer than 200 licensed beds, for non-inpatients whose main disease is one of the Appendix Table 1 diseases |
| Requirement | Prescription period of 28 days or more (not every drug has to be 28 days or more) |
| Prescription fee and slip fee | If both are billed in the same month, once a month as an addition to one of them |
| First visit day | Billable even on the day of the first visit for which the initial consultation fee is billed |
The management fee has a "one month after the first visit" restriction, but the prescription management addition can be billed on the first visit day. This difference is easily confused in billing software settings.
Notice to post in the clinic: long-term and refill prescriptions
The implementation notice requires a medical institution billing the specific disease management fee to post in a visible place that it can prescribe for 28 days or more, or issue refill prescriptions, according to the patient's condition, and to respond appropriately when a patient asks. Check that your posted notice is up to date.
Pre-billing checklist
- Is the main disease (the center of overall medical management) one of the Appendix Table 1 diseases?
- Is the diagnosis registered under the classification name (or an equivalent)?
- Is it on or after the day one month has passed from the first visit (discharge) date?
- Is billing within twice in the same month?
- Are other specific-disease fees, home care guidance fees or comprehensive home care fees not billed in the same month?
- For gastric or duodenal ulcer, have you checked for a contraindicated NSAID?
- Is there a treatment plan, and are the key points of management in the chart?
- Is the notice on long-term and refill prescriptions posted?
FAQ
Q. Can we bill the fee for patients with diabetes or hypertension? A. Diabetes and hypertension are not in Appendix Table 1; they fall under the lifestyle disease management fee. Consider billing only when another Appendix Table 1 disease (for example ischemic heart disease or chronic liver disease) is the main disease.
Q. What if there are multiple main diseases? A. The main disease is the specific disease at the center of the patient's overall medical management. When a patient visits several departments in one institution, only the department treating the main disease can bill.
Q. Can we bill it if only a family member comes? A. Yes, when a planned treatment plan based on examination exists and it is unavoidable, management through the family member caring for the patient is also billable.
Q. Do we need management at every one of the two monthly billings? A. The limit is "up to" twice a month. Each billing requires management based on the treatment plan and a chart record of the key points.
Q. Can it be billed for online care? A. A notified institution can bill it, for example at 196 points for a clinic, when management follows the online care guidelines.
Summary
- The specific disease management fee is 225 points for clinics, up to twice a month, for patients whose main disease is an Appendix Table 1 disease; hospitals with 200 or more beds cannot bill it
- Bill on or after the day one month has passed from the first visit (discharge) date. Billing in the month of the first visit is generally wrong
- In FY2026, gastric and duodenal ulcer cases receiving an NSAID that is contraindicated for peptic ulcer were removed. It is not a blanket exclusion
- Many fees cannot be combined with it, including home care guidance and comprehensive home care fees. Make a month-end check a habit
- The specific disease prescription management addition uses the same list, but can be billed on the first visit day
For distinguishing it from the lifestyle disease management fee, see Lifestyle Disease Management Fee I vs II; for billing checks in internal medicine clinics, see Internal Medicine Clinic EMR and AI Billing Check; for the full FY2026 revision, see Medical Fee Revision 2026. For other internal medicine additions such as the community comprehensive care addition, see Community Comprehensive Care Addition, and for operations that prevent missed billing, see Why Billing Is Missed: A Cause-by-Cause Checklist.
Pottech provides AI electronic medical records and billing check functions for clinics that reflect billing requirements. If you have questions about checking combination rules for management fees or reviewing settings after a revision, please feel free to contact us.
参考・出典
- 厚生労働省「診療報酬の算定方法の一部を改正する件」（令和8年厚生労働省告示第69号）医科診療報酬点数表（B000 特定疾患療養管理料、B001 各管理料の注、処方料・処方箋料の注） https://www.mhlw.go.jp/content/12400000/001686842.pdf
- 厚生労働省保険局医療課「診療報酬の算定方法の一部改正に伴う実施上の留意事項について」（令和8年3月5日保医発0305第6号、1007訂正後）別添1（医学管理等通則、B000、在宅時医学総合管理料、特定疾患処方管理加算） https://www.mhlw.go.jp/content/12400000/001757385.pdf
- 厚生労働省「特掲診療料の施設基準等の一部を改正する件」（令和8年厚生労働省告示第71号）別表第一 https://www.mhlw.go.jp/content/12400000/001675855.pdf
- 厚生労働省「令和8年度診療報酬改定について」個別改定事項（外来医療の機能分化・強化等、特定疾患療養管理料の見直し） https://www.mhlw.go.jp/content/12400000/001681336.pdf